本课目标

学完本课，你能够：

• 用现在完成时说明症状持续到现在；
• 区分 for + 时长 与 since + 起点；
• 用一般过去时说明症状何时开始；
• 说明什么会让症状变好或变坏；
• 回答一次基础问诊追问，不自行作诊断。

安全边界

本课只训练沟通，不判断病因，也不提供药物或治疗建议。MedlinePlus建议就诊前记录症状何时开始、什么会使其改善或加重；如出现呼吸困难等紧急警示，应立即寻求当地紧急医疗帮助。参见MedlinePlus就医沟通建议和CDC呼吸道疾病紧急警示。

场景词汇

• cough 咳嗽
• dry 干咳的
• sore throat 喉咙痛
• fever 发热
• shortness of breath 呼吸急促／气短
• symptom 症状
• get worse 加重
• intake nurse 负责初步信息登记的护士

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A phone intake before an appointment

Daniel calls a neighborhood clinic. An intake nurse asks for information that will be passed to the clinician; the nurse does not diagnose him on the call.

Part A — Duration and start

Nurse: What would you like help with today?

Daniel: I've had this cough for a week. It started last Monday.

Nurse: Has it stayed the same?

Daniel: No. It was dry for the first three days, but it's been worse since Friday.

Nurse: When does it usually get worse?

Daniel: It gets worse when I lie down at night. Warm drinks seem to make my throat feel better for a little while.

Nurse: Have you had a fever?

Daniel: I haven't had a fever. I checked twice yesterday and once this morning.

Part B — Related information

Nurse: Have you noticed any shortness of breath or chest pain?

Daniel: No, I haven't noticed either of those.

Nurse: Are you taking any medicines or supplements?

Daniel: Just my usual daily vitamin. I haven't taken anything specifically for the cough.

Nurse: Is there anything else you want the clinician to know?

Daniel: That's everything I've noticed: one week, worse since Friday, mostly at night, no fever, and no trouble breathing.

Nurse: Thank you. I'll add that to your appointment note. If your symptoms become severe or you develop an emergency warning sign, seek urgent help rather than waiting for this appointment.

Daniel: Understood. Thank you.

Daniel attends the scheduled appointment later that day. The lesson does not state a diagnosis or treatment.

Check the story

1. How long has Daniel had the cough?
2. When did it start?
3. How has it changed since Friday?
4. When does it get worse?
5. What related symptoms does he say he has not noticed?
6. Does the nurse diagnose him?

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A. Symptom note

Appointment note — patient report
Main concern: cough
Started: Monday
Duration today: 7 days
Change: worse since Friday
Pattern: worse when lying down at night
Reported fever: no
Reported shortness of breath: no
Reported chest pain: no

根据记录写两句：一句用 for，一句用 since。然后列出三项明确报告为“没有”的情况。

B. What belongs in a symptom description?

将信息分为：start / duration / change / pattern / related symptom。

1. last Monday
2. for seven days
3. worse since Friday
4. worse when lying down
5. no reported fever

C. 记录事实，不自行下结论

I have a cough 是个人可报告的症状；I have pneumonia 是诊断性结论，除非专业人员已经作出诊断，否则本课不要求这样说。

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本课负荷说明

本课有6项全新主动表达：第1—6项。第7—10项是问诊中常见的追问和回应。

1. I've had this … for …

这个……持续……了。用于从过去开始并持续到现在的症状。

I've had this headache for two days.

2. It started …

它在……开始。后接明确过去时间。

It started on Tuesday evening.

3. It's been worse since …

从……起更严重了。since 后接起点。

It's been worse since yesterday morning.

4. It gets worse when …

当……时会更严重。描述反复出现的规律，不等于说明病因。

It gets worse when I walk upstairs.

5. I haven't had any …

我没有出现任何……。只报告自己知道的情况。

I haven't had any fever.

6. That's everything I've noticed.

我注意到的就是这些。用于结束当前描述；如果想起新信息仍应补充。

7. Has it stayed the same?

一直没有变化吗？用于询问变化。

8. When does it get worse?

什么时候会加重？询问模式，不暗示原因。

9. Have you noticed …?

你有没有注意到……？回答应如实，不猜测。

10. I'll add that to your note.

我会把它加入记录。表示信息被记录，不等于作出诊断。

Don't Say It That Way

容易说出的句子	更自然的表达	原因
I cough one week.	I've had this cough for a week.	表达持续到现在
Since one week.	For one week.	时长用 for
I have this since Monday.	I've had this since Monday.	结构和起点都完整
I know what disease it is.	These are the symptoms I've noticed.	不自行作诊断

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1. for + 一段时间

for a week / for three days / for about a month

I've had the cough for a week.

2. since + 起点

since Monday / since Friday night / since I came home

It's been worse since Friday.

3. 一般过去时说明开始点

It started last Monday.

不要说 It has started last Monday；明确的完成过去时间通常与一般过去时搭配。

4. 否定持续到现在

I haven't had a fever.
I haven't noticed chest pain.

快速练习

1. I've had this headache __________ two days.
2. It's been worse __________ Tuesday.
3. It __________ last weekend. (start)
4. I __________ had any fever. (not)
5. I've felt tired __________ I returned from the trip.

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本课网页已配有完整对话、逐句播放和影子跟读。重点听症状持续时间、开始时间、变化和相关信息；本课训练表达，不用于自我诊断。

I've had 在自然语流中连接紧密，最重要的信息通常是症状和时间：

I've had this COUGH / for a WEEK.
It's been WORSE / since FRIDAY.

录音

用不同症状替换，录三组“持续时间—开始点—变化”。回听时确认 for 后是时长，since 后是起点。

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A. 理解检查

1. Daniel's cough started on Friday.
2. It was dry for the first three days.
3. It gets worse when he lies down at night.
4. Daniel reports a fever.
5. The nurse gives him a diagnosis.
6. Daniel attends an appointment later that day.

B. for还是since

1. __________ five days
2. __________ last Thursday
3. __________ I returned home
4. __________ about two hours
5. __________ midnight

C. 完成症状记录

根据材料说4—6句：

sore throat; started Saturday; three days; worse since last night; worse when speaking; no reported fever

D. 基础追问

伙伴从以下选择一个症状卡：headache / sore throat / back pain。你只能问开始时间、持续多久、变化、加重模式和相关情况，不问诊断。伙伴可回答“不确定”，你要准确记录。

E. Lesson 20间隔检索（一）

1. A repair was promised by noon, but it is still incomplete. Refer calmly to the promised completion time.
2. At a station, ask whether there is a place where your group can store its bags.
3. Your reserved room has no working light. Ask whether the hotel can provide a different room.

F. 独立录音

用第3部分症状卡录60—90秒。只说可观察信息，不猜病因、不推荐药物。

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现实沟通任务

选择一个虚构、非紧急症状，写五个关键词：symptom / start / duration / change / pattern。伙伴随机追问两项，你在60—120秒内回答，并明确哪些相关情况没有出现或自己不确定。

实用写作

给诊所写50—70词预约说明，包含症状、开始时间、持续时长、变化和两项相关情况。不要写自我诊断。收到“请补充何时加重”的回复后，再写25—40词补充。

三天后的复习

不看教材，根据一张新症状卡回答五类问题。若混淆 for / since / started，重做第5部分。

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为每项选择：能做到／还不稳定／需要重学。

• 我能用 for 说明时长，用 since 说明起点。
• 我能用一般过去时说明症状何时开始。
• 我能描述变化和加重模式。
• 我能如实报告相关情况，也能说“不确定”。
• 我不会根据症状自行作诊断或给出药物建议。
• 我知道严重或紧急情况不应等待教材练习，应联系当地专业医疗或紧急服务。

如果有两项以上选择“需要重学”，重做第3、5、7部分。